P05-17 Assessing the impact of care-physical activity initiatives for people with a low socioeconomic status on healthcare utilisation: an exploratory study

Abstract Background Care-physical activity (care-PA) initiatives are being implemented in the Netherlands to stimulate the health of citizens with a low socioeconomic status (SES), with the aim of reducing health inequality and healthcare utilisation. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. As the impact of care-PA initiatives on healthcare utilisation has not yet been studied, our research question was: ‘What is the impact of participation in a care-PA initiative on the healthcare utilisation of citizens with a low SES?’. Methods We studied the healthcare utilisation of 44 former participants of X-Fittt 2.0, focussing on general practitioner care, pharmaceutical care, hospital care, paramedical care, medical aids and mental healthcare. We compared utilisation intensity (number of healthcare claims) during the two years before participation in X-Fittt 2.0 (period 1) with utilisation intensity during the two years after initial participation (period 2) using paired t-tests. Results As expected, utilisation intensity increased significantly for paramedical care for non-chronic disorders after participation. No differences in utilisation intensity were observed for the other healthcare categories. Furthermore, although it was not the core focus of this study, our results show that people with a low SES tend to have higher healthcare utilisation than those with a higher SES. Conclusions This exploratory study, which is unique for its use of healthcare claims data for participants of a care-PA initiative, shows a statistically significant increase in utilisation intensity for paramedical care (supplementary healthcare insurance for non-chronic conditions) in period 2 compared with period 1, as expected. This increase is likely caused by a greater utilisation intensity for physiotherapy, which covers respectively 95% and 92% of the paramedical healthcare claims of the supplementary healthcare insurance in periods 1 and 2. The design of our study can be used as a template for future research that aims to study health care utilisation over a longer time period. The results of this and future studies can be used to improve health policies.


Background
Care-physical activity (care-PA) initiatives are being implemented in the Netherlands to stimulate the health of citizens with a low socioeconomic status (SES), with the aim of reducing health inequality and healthcare utilisation. A twoyear care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. As the impact of care-PA initiatives on healthcare utilisation has not yet been studied, our research question was: 'What is the impact of participation in a care-PA initiative on the healthcare utilisation of citizens with a low SES?'.

Methods
We studied the healthcare utilisation of 44 former participants of X-Fittt 2.0, focussing on general practitioner care, pharmaceutical care, hospital care, paramedical care, medical aids and mental healthcare. We compared utilisation intensity (number of healthcare claims) during the two years before participation in X-Fittt 2.0 (period 1) with utilisation intensity during the two years after initial participation (period 2) using paired t-tests.

Results
As expected, utilisation intensity increased significantly for paramedical care for non-chronic disorders after participation. No differences in utilisation intensity were observed for the other healthcare categories. Furthermore, although it was not the core focus of this study, our results show that people with a low SES tend to have higher healthcare utilisation than those with a higher SES.

Conclusions
This exploratory study, which is unique for its use of healthcare claims data for participants of a care-PA initiative, shows a statistically significant increase in utilisation intensity for paramedical care (supplementary healthcare insurance for non-chronic conditions) in period 2 compared with period 1, as expected. This increase is likely caused by a greater utilisation intensity for physiotherapy, which covers respectively 95% and 92% of the paramedical healthcare claims of the supplementary healthcare insurance in periods 1 and 2. The design of our study can be used as a template for future research that aims to study health care utilisation over a longer time period. The results of this and future studies can be used to improve health policies. Keywords: Lifestyle intervention, Physical activity, Low socioeconomic status, Health promotion, Healthcare utilisation Abstract citation ID: ckac095.085 P05-18 The impact of a care-physical activity initiative for people with a low socioeconomic status on health, quality of life, and societal participation Background Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may improve participants' lifestyles and thereby lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. Here, we study the impact of X-Fittt 2.0 on health, quality of life (QoL), and societal participation using a mixedmethods design. Methods Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), one year (t2) and two to three years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using a linear mixed-model analysis (corrected for gender, age at t0, height, education level and employment status at the different time points), while we used descriptive statistics for the categorical variables. Qualitative data were analysed using a thematic analysis.

Results
Body weight was significantly lower at all three post-initiative time points compared with the baseline, with a maximum of 3.8 kg difference at t2. BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks. A positive trend regarding paid work was observed, while social visits decreased. The latter might be explained by the COVID-19 pandemic, as lockdowns limited social life. Furthermore, participants reported increased PA (including sports) and a few stopped smoking or drinking alcohol. Participants mentioned feeling healthier, fitter and more energetic. Additionally, participants' self-esteem and stress levels improved, stimulating them to become more socially active. However, the participants also mentioned barriers to being physically active, such as a lack of money or time, or physical or mental health problems. Conclusions X-Fittt 2.0 improved the health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results. More complete data are needed to confirm the findings.

Background
The continued prevalence of positive samples to banned performance-enhancing drugs confirms the importance to maintain the anti-doping efforts. Though the role of sociocognitive variables in doping attitudes is well identified (e.g., Ntoumanis et al., 2014), the role of implicit processes remains sparsely studied in sports' doping, especially in high level cyclists. While the potential of traditional computer-IAT has been developed to capture individuals' implicit attitudes toward doping (Brand et al., 2014ab;Schindler et al., 2015), paper-and-pen IAT offers unquestionably ease-of-administration prospects (Chan and al., 2017). The aim of this study was thus to test and provide a preliminary validation of a French paper-and-pen IAT as an alternative method to measure implicit attitudes toward doping: the IAT-Dop.